One moment please...

PLEASE READ 

MAX'S PARTNERS WITH PEACE OF MIND DOG RESCUE'S "HELPING PAW PROGRAM" AND CAN SHARE YOUR APPLICATION.

Please wait for a confirmation page to come up to confirm receipt of your application. If you do not see this page, please look for notes about missed fields. If you choose to email documentation to admin@maxshelpingpaws.org rather than uploading through this application, that will delay processing of your application.

CLIENT APPLICATION FOR SUPPORT

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* Financial assistance has a limit of assistance for one pet/one situation/one family/one-year
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Please be specific. Explain how COVID impacted your employment, such as "I worked for a restaurant that had to shut down."

PET INFORMATION

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Provide as much detail as possible such as how this illness or injury occurred, why you are applying for assistance. Incomplete information may delay processing.
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(If you do not have a regular veterinarian, explain why not here)
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PET OWNER & SPOUSE/PARTNER/PET CO-OWNER INFORMATION

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First Name
Last Name
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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HOUSEHOLD FINANCIAL INFORMATION

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ie CalWorks/CalFresh, CalWater (LIRA),PG&E (REACH)/PG&E (CARE),(CHIP), Disability, Social Security (SSI) or (SSP), AT&T Lifeline, HHS (HEAP), CHISPA, Medi-Cal for Aged and Disabled Covered California Silver Government Programs require proof of participation to be used to meet proof of need requirement
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Your application cannot be processed until this is received.


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DOCUMENTATION/APPLICATION SUPPORT - REQUIRED (ID, PROOF OF FINANCIAL NEED, PET PHOTO) 

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Ideally LANDSCAPE Orientation (Camera turned on side)
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You must submit either through form or by sending photo of your ID/DL to admin@maxshelpingpaws.org
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Can be Paystub, Employer Letter, Bank Account, Tax Return Page, other.

Your application cannot be processed until this is received, unless you have shown proof of inclusion in a government program. When you apply, TAKE A PHOTO with your phone of the instant decision - otherwise it takes 8-10 days to receive via mail.


(see accepted options noted in application)


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BY SUBMITTING THIS APPLICATION, I CONFIRM I UNDERSTAND AND AGREE TO THE BELOW:
  • If I have Care Credit funds, I may be asked to use some available credit towards the pet's treatment unless I show documentable proof of need to use it elsewhere.
  • Pets that receive MHPF funding must be spayed or neutered unless medically not advised or other approved reason. If my pet is not spayed/neutered at the time funding is given, I agree to have my pet spayed/neutered within 90 days.
  • I provide consent for MHPF to share my application in order to secure additional funding in connection with my request for financial assistance from MHPF
  • I agree to allow MHPF to interview me and will share photos and videos to be used for fundraising purposes. Follow-up after recovery is a requirement of this grant.
  • I consent to use of my pet’s name, image & story by MHPF for website, PR, and other marketing purposes, AND I will cooperate with MHPF to schedule photos, interviews or video as necessary for their use.
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